The influence of career aspirations on medical school choice: a national qualitative interview study of applicants to UK medical schools

Problem

The NHS is critically short of doctors. The sustainability of the UK medical workforce depends on medical schools producing more future GPs who are able and willing to care for under-served patient populations. The evidence for how medical schools should achieve this is scarce. We know medical schools vary in how they attract, select, and educate future doctors. We know some medical schools produce more GPs, but it is uncertain whether those school recruit more students who are interested in general practice or whether their curriculum influences career aspirations.This study sought to explore how applicants’ future speciality ambitions influenced their choice of medical school.

Approach

We conducted a national qualitative interview study, taking a critical realist perspective. We purposively sampled applicants and recent entrants to eight UK medical schools. Data were collected through individual and group interviews. Interviews were audio recorded and transcribed verbatim. Transcripts were analysed through framework analysis by one researcher. A sample of 20% of transcripts were analysed by a second researcher.

Findings

Sixty-six individuals participated in 61 individual and one group interview. Interviews lasted a mean of 54 minutes (range 22–113). Twelve expressed interest in general practice, 40 favoured other specialities, and 14 were unsure.Three themes were identified from the analysis: speciality motivations, matching aspirations to course, medical school attributes.Participants described their speciality aspirations and what had drawn them to these specialities. Many participants described becoming attracted to specific specialities through work experience, or family experience of care. For those that had identified speciality aspirations prior to applying to medical schools, few described their speciality aspirations influencing their choice of medical school. It appeared, rather, that there were other factors that drew them both to their chosen medical schools and their speciality of interest.Participants’ priorities of medical school attributes varied by speciality aspiration; those interested in general practice described favouring medical schools with early clinical experience and problem-based learning curricula, and were less concerned with cadaveric dissection and the prestige of the medical school.

Consequences

Many applicants do consider future speciality ambitions before applying to medical school. Participant speciality aspiration, however, doesn’t appear to explicitly influence choice of medical school, rather it appears that this is mediated by curricula features of these medical schools.Further longitudinal research exploring the influences on career aspirations will help us to better understand and plan for future workforce needs.